Renal Function in Diabetic Disease Models: The Tubular System in the Pathophysiology of the Diabetic Kidney
Open accessAbstract
Diabetes mellitus affects the kidney in stages. At the onset of diabetes mellitus, in a subset of diabetic patients the kidneys grow large, and glomerular filtration rate (GFR) becomes supranormal, which are risk factors for developing diabetic nephropathy later in life. This review outlines a pathophysiological concept that focuses on the tubular system to explain these changes. The concept includes the tubular hypothesis of glomerular filtration, which states that early tubular growth and sodium-glucose cotransport enhance proximal tubule reabsorption and make the GFR supranormal through the physiology of tubuloglomerular feedback. The diabetic milieu triggers early tubular cell proliferation, but the induction of TGF-β and cyclin-dependent kinase inhibitors causes a cell cycle arrest and a switch to tubular hypertrophy and a senescence-like phenotype. Although this growth phenotype explains unusual responses like the salt paradox of the early diabetic kidney, the activated molecular pathways may set the stage for tubulointerstitial injury and diabetic nephropathy.
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SGLT2 inhibitors suppress glomerular hyperfiltration, likely reflecting reduced intraglomerular pressure in response to reduced proximal tubule Na reabsorption.
“SGLT2 inhibitors (SGLT2i) suppress glomerular hyperfiltration, likely reflecting reduced intraglomerular pressure in response to reduced PT Na ϩ reabsorption (38,39).”
From Evaluation of renal and cardiovascular protection mechanisms of SGLT2 inhibitors: model-based analysis of clinical data (2018) · cites this paper as [38]
TGF provides a partial correction by increasing GFR, but if the pressure-natriuresis mechanism does not sufficiently adjust distal Na+ reabsorption, any remaining Na+ imbalance will cause additional fluid retention, increases in renal perfusion pressure, and increasing glomerular pressure and GFR until Na+ excretion again equals intake.
“TGF provides a partial correction by increasing GFR (although hyperfiltration will occur even in the absence of TGF) (38), but if the pressure-natriuresis mechanism does not sufficiently adjust distal Na ϩ reabsorption, any remaining Na ϩ imbalance will cause additional fluid retention, increases in renal perfusion pressure, and increasing glomerular pressure and GFR until Na ϩ excretion again equ”
From Evaluation of renal and cardiovascular protection mechanisms of SGLT2 inhibitors: model-based analysis of clinical data (2018) · cites this paper as [38]
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Resetting protects efficiency of tubuloglomerular feedback
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Self-citationSLC2A2 gene expression in kidney of diabetic rats is regulated by HNF-1α and HNF-3β
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SGK1-sensitive renal tubular glucose reabsorption in diabetes
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Self-citationTGF-βbgr;1 stimulates the release of pre-formed bFGF from renal proximal tubular cells
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The salt paradox and its possible implications in managing hypertensive diabetic patients
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Self-citationPrimary kidney growth and its consequences at the onset of diabetes mellitus
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Self-citationOsmotic diuresis in a mathematical model of the rat proximal tubule
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Converting Enzyme Inhibition and the Glomerular Hemodynamic Response to Glycine in Diabetic Rats
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Self-citationRenal sodium metabolism in relation to hypertension in diabetes.
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Miracle, C. M., Rieg, T., Mansoury, H., Vallon, V., & Thomson, S. C. (2008) · American Journal of Physiology-Renal Physiology · doi:10.1152/ajprenal.00491.2007 · Cited by 18 · see citing works
Self-citationThe Salt Paradox of the Early Diabetic Kidney Is Independent of Renal Innervation
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Self-citationRelationship between kidney volume, microalbuminuria and duration of diabetes mellitus.
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藤田尚代 (2007) · Institutional Repositories DataBase (IRDB) · Cited by 3 · see citing works
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Vallon, V., & Thomson, S. C. (2017) · Diabetologia · doi:10.1007/s00125-016-4157-3 · Cited by 635 · see citing works
Self-citationMudaliar, S., Alloju, S., & Henry, R. R. (2016) · Diabetes Care · doi:10.2337/dc16-0542 · Cited by 571 · see citing works
Vallon, V., Gerasimova, M., Rose, M. A., Masuda, T., Satriano, J., Mayoux, E., Koepsell, H., Thomson, S. C., & Rieg, T. (2014) · American Journal of Physiology-Renal Physiology · doi:10.1152/ajprenal.00520.2013 · Cited by 483 · see citing works
Self-citationThe tubular hypothesis of nephron filtration and diabetic kidney disease
Vallon, V., & Thomson, S. C. (2020) · Nature Reviews Nephrology · doi:10.1038/s41581-020-0256-y · Cited by 465 · see citing works
Self-citationProbing SGLT2 as a therapeutic target for diabetes: basic physiology and consequences
Gallo, L. A., Wright, E. M., & Vallon, V. (2015) · Diabetes and Vascular Disease Research · doi:10.1177/1479164114561992 · Cited by 395 · see citing works
Self-citationVallon, V., Rose, M., Gerasimova, M., Satriano, J., Platt, K. A., Koepsell, H., Cunard, R., Sharma, K., Thomson, S. C., & Rieg, T. (2013) · American Journal of Physiology-Renal Physiology · doi:10.1152/ajprenal.00409.2012 · Cited by 370 · see citing works
Self-citationHallow, K. M., Gebremichael, Y., Helmlinger, G., & Vallon, V. (2017) · American Journal of Physiology-Renal Physiology · doi:10.1152/ajprenal.00497.2016 · Cited by 98 · see citing works
Self-citationOnishi, A., Fu, Y., Darshi, M., Crespo-Masip, M., Huang, W., Song, P., Patel, R., Kim, Y. C., Nespoux, J., Freeman, B., et al. (2019) · American Journal of Physiology-Renal Physiology · doi:10.1152/ajprenal.00497.2018 · Cited by 71 · see citing works
Self-citationHallow, K. M., Greasley, P. J., Helmlinger, G., Chu, L., Heerspink, H. J., & Boulton, D. W. (2018) · American Journal of Physiology-Renal Physiology · doi:10.1152/ajprenal.00202.2018 · Cited by 68 · see citing works
Bamgboye, A. O., Oni, I. O., & Collier, A. (2021) · European Journal of Clinical Pharmacology · doi:10.1007/s00228-020-03051-3 · Cited by 48 · see citing works
Hallow, K., & Gebremichael, Y. (2017) · CPT: Pharmacometrics & Systems Pharmacology · doi:10.1002/psp4.12177 · Cited by 23 · see citing works
Balazki, P., Schaller, S., Eissing, T., & Lehr, T. (2018) · CPT: Pharmacometrics & Systems Pharmacology · doi:10.1002/psp4.12359 · Cited by 19 · see citing works
- Authors
- Vallon, V., & Thomson, S. C.
- Affiliations
- University of California San Diego (US)
- VA San Diego Healthcare System (US)
- Venue
- Annual Review of Physiology
- Publisher
- Annual Reviews
- Published
- 2012-03-17
- Volume
- 74
- Issue
- 1
- Pages
- 351-375
- ISSN
- 0066-4278 (ISSN-L)
- 1545-1585
- PMC
- PMC3807782
- OpenAlex
- W2112710337
- Cited by
- 376
- References
- 153
- Citations by year
- 2026: 14 · 2025: 21 · 2024: 25 · 2023: 35 · 2022: 40 · 2021: 30 · 2020: 21 · 2019: 25 · 2018: 34 · 2017: 30 · 2016: 22 · 2015: 28 · 2014: 24 · 2013: 19 · 2012: 8
- FWCI
- 2.17
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annual Review of Physiology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Heart, Lung, and Blood Institute (R01HL094728)
- National Institute of General Medical Sciences (R01GM66232, R01GM066232)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK-56248, R01-DK28602, R01DK028602, P30DK079337, R01DK056248)
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Nephrology › Renal Diseases and Glomerulopathies
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Keywords
- diabetic nephropathy, tubuloglomerular feedback, glomerular filtration rate, proximal tubular reabsorption, sodium-glucose cotransport, tubular cell proliferation, TGF-beta, cyclin-dependent kinase inhibitors, cell cycle arrest, tubular hypertrophy, senescence, tubulointerstitial injury, diabetic kidney
- MeSH terms
- Animals, Diabetic Nephropathies, Electrolytes, Glomerular Filtration Rate, Glucose, Humans, Hypertrophy, Kidney Glomerulus, Kidney Tubules, Kidney Tubules, Proximal, Sodium, Sodium Chloride, Disease Progression, Feedback, Physiological, Glucose Transport Proteins, Facilitative, Glucose Transporter Type 2
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